The highest prognostic impact of LDH among International Prognostic Indices (IPIs): an explorative study of five IPI factors among patients with DLBCL in the era of rituximab
The highest prognostic impact of LDH among International Prognostic Indices (IPIs): an explorative study of five IPI factors among patients with DLBCL in the era of rituximab
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DOI：
10.1007/s00277-014-2115-z
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发表时间：
2014-10-01
影响因子：
3.5
通讯作者：
Suh, C.
中科院分区：
文献类型：
--
作者：
Park, J. H.;Yoon, D. H.;Suh, C.
尽管国际预后指数（IPI）被认为是弥漫性大B细胞淋巴瘤（DLBCL）的标准诊断系统，但同一IPI风险组中的患者存在预后异质性。因此，我们研究了同一IPI评分内5个IPI因子的分布模式和预后影响。我们回顾性分析了2002年2月至2010年2月期间387例新诊断为病理证实的DLBCL患者的病历。我们根据IPI风险评分对患者进行分类，并根据IPI的组合对其进行分类。然后，我们探讨了五个IPI因素的频率，并分析了这些亚组与疗效结局之间的相关性：完全缓解（CR），无事件生存期（EFS）和总生存期（OS）。该队列中IPI评分的生存估计值与经典IPI评分一致。血清乳酸脱氢酶（LDH）水平升高是所有评分中最常见的分布因素，无论IPI评分如何，血清LDH水平升高的患者往往具有较低的CR、较差的EFS和/或OS。特别是，在IPI评分为2的亚组中，血清LDH水平升高与CR（73.1 vs 95.2%）、3年EFS（57 vs 87%）和3年OS（58 vs 82%）较差显著相关。此外，较高的血清LDH水平，特别是高于2，000 IU/L，与较差的生存结局显著相关（3年EFS 78.0 vs 58.5 vs 45.5 vs 20.0%，3年OS 86.0 vs 66.2 vs 58.2 vs 40.0%）。总之，在IPI的五个因素中，血清LDH水平升高似乎是最常见的分布，更重要的是，最相关的IPI因素与最高的预后影响。这些发现仍然需要在更大的队列中进一步验证。
Although the International Prognostic Index (IPI) is considered as the current standard prognostication system for diffuse large B-cell lymphoma (DLBCL), prognostic heterogeneity is suggested to exist among the patients within the same IPI risk group. Hence, we investigated the pattern of distribution and prognostic impact of five IPI factors within the same IPI score. We retrospectively reviewed the medical records of 387 patients newly diagnosed as pathologically proven DLBCL between February 2002 and February 2010. We classified patients to IPI risk scores and categorized them according to the combinations of IPI. Then, we explored the frequency of five IPI factors and analyzed the correlation between these subgroups and efficacy outcomes: complete response (CR), event-free survival (EFS), and overall survival (OS). Survival estimates by IPI score in this cohort corresponded to the classic IPI. Elevated serum level of lactate dehydrogenase (LDH) was the most prevalently distributed factor throughout the scores, and patients with elevated serum level of LDH tended to have lower CR, inferior EFS, and/or OS irrespective of IPI scores. Particularly, among the subgroups of IPI score of 2, elevated serum level of LDH was significantly associated with inferior CR (73.1 vs 95.2 %), 3-year EFS (57 vs 87 %), and 3-year OS (58 vs 82 %). In addition, the higher serum level of LDH, particularly above 2,000 IU/L, was significantly correlated with the inferior survival outcomes (3-year EFS 78.0 vs 58.5 vs 45.5 vs 20.0 %, 3-year OS 86.0 vs 66.2 vs 58.2 vs 40.0 %). In conclusion, among five factors of IPI, elevated serum level of LDH seems to be the most frequently distributed and, more importantly, the most relevant IPI factor with the highest prognostic impact. These findings still warrant further validation in larger cohorts.